Objective To assess the clinical efficacy of TIPS in the treatment of patients with refractory ascites and investigate the clinical factors associated with TIPS. Methods 21 consecutive patients with refractory ascites, 16 men and 5 women with mean age of 45 years (range 22-69 years) were followed up for an average of 337 days (range 50-1323 days). Asites/ abdomen circumference, serum parameters, stents function, time of followed up and survival rate were analized. Results The ascites was significantly reduced as compared with basal values (P

Objective To assess the clinical value of pre-operative embolization for nasopharyngeal angiofibroma. Methods 13 patients with nasopharyngeal angiofibroma confirmed by surgery and biopsy were retrospectively analysed. Bilateral carotid artery angiograpy was perfomed for demonstration of the arterial supply of tumor. According to the size and different caliber of arteries, embolization were seperately undertaken by different types of coil via 4.1or 5F Head-Hunter catheter. The embolization efficacy, embolization was evaluated by amount of blood loss. Results After coil embolization , no complication happened ranging 1～4 days (mean 2 days) in all 13 patients and then all the tumor masses were totally resected with mean blood loss of (584.6?379.4) ml (range 250～1500 ml). Conclusions Preoperative coils embolization is safe, reliable with less complication especially for reducing intraoperative blood loss and promoting the prognosis.

0.05). The most frequent side-effects were abdominal pain and fever. The degree and duration of abdominal pain were higher and longer in group B than those in group A, but the occurrance rate of fever was lower in group B. The occurrance rate of severe complications showed no significant differences for both groups. The increase of embolization degree may aggravate post-embolization side-effects and raise the incidence of complications. Conclusions PVA may be used as the embolic material of PSE with embolization degree ranging from 50% to 70% which may alleviate hypersplenism in patients with cirrhosis, relieve post-embolization syndrome and decrease the incidence of severe complications.

Objective To study the therapeutic effect, side-effect and safety of uterine artery embolization of hysteromyoma with pinyangmycin and lipiodol emulsion. Methods Embolization carried out selectively through uterine artery with pinyangmycin and lipiodol emulsion of 158 hysteromyoma was followed up for 3-18 months with observation of the size of hysteromyoma, the change of corpus uteri and the degree of reactions. Results All cases were embolized successfully including 150 cases of bilateral and 8 cases of unilateral uterine arterial embolization. The appearance of uterine arteries showed obvious arterial enlargement with spiral hypervasculature, tumor staining and prolonged opacification. Six patients underwent hysteroectomy 1 week after the embolization. The specimens demonstrated flaky necrosis with small bloody specks under pathologic examination. The alleviation rate of symptoms were 90.5% with recovery of normal menstrual cycle as 89.4%. The compressive symptoms of hypogastric pain and abdominal distention disasppeared in 91.3%. The reduction in size of hysteromyoma and corpus utei were 80% and 48% on average respectively. Conclusion The primary results demonstrates that uterine artery embolization of hysteromyoma is safe and effective, with low complication rate and more advantage over surgical approach.

Objective To discuss the perioperative nursing norm for patients who are suffering from biliary complications occurred after liver transplantation and who will receive interventional management to treat the complications.Methods Interventional therapies were performed in 20 patients with biliary complications due to liver transplantation.The interventional procedures performed in 20 cases included percutaneous biliary drainage(n = 13), percutaneous biliary balloon dilatation(n = 5) and biliary stent implantation(n = 7).The clinical results were observed and analyzed.Results Biliary tract complications occurred after liver transplantation were seen frequently.Proper interventional management could markedly improve the successful rate of liver transplantation and increase the survival rate of the patients.In accordance with the individual condition, proper nursing measures should be taken promptly and effectively.Conclusion Conscientious and effective nursing can contribute to the early detection of biliary complications and, therefore, to improve the survival rate of both the transplanted liver and the patients.

Objective To determine the relationship between visual signal intensity and quantitative signal intensity of HCC assessed with DWI and histopathological differentiation of HCC.Methods The MR examinations including MRI plain scan,LAVA dynamic enhanced scan and DWI (1.5T,b value:0 and 600 s/mm2) of 224 patients who had surgically resected HCCs were retrospectively reviewed.Histopathological examinations revealed that there were 31 well-,169 moderately-,and 24 poorly-differentiated HCCs.The incidence of each visually evaluated signal intensity and quantitative signal intensity of HCC assessed with DWI signal intensity and the relationship between signal intensity and histopathological differentiation were assessed for each sequence.Results (1) On DWI,56.7％ of HCCs appeared as obviously hyperintense,24.1％ tumors appeared as moderate hyperintense,and 19.2％ tumors appeared as isotense or slight hyperintense to the surrounding hepatic parenchyma.There was a significant difference between isotense/slight hyperintense and obvious hyperintense and histopathological differentiation (P ＜ 0.05).There was no significant difference between isotense/slight hyperintense and moderate hyperintense and histopathological differentiation (P ＜ 0.05).There was no significant difference between moderate hyperintense and obvious hyperintense and histopathological differentiation (P ＞ 0.05).Visually evaluated signal Intensity of HCC showed an inverse correlation with histopathological differentiation (r =-0.324,P ＜ 0.05).On DWI,the tumors tended to show a brighter signal with decreasing histopathological differentiation.(2) There was a significant difference in DWI signal intensity value among the well,moderately and poorly differentiated HCCs (P ＜ 0.05).The SI value of well differentiated HCCs was lower than that of moderately differentiated HCCs and poorly differentiated HCCs (P ＜ 0.05).The SI value of moderately differentiated HCCs was lower than that of poorly differentiated HCCs.However,there was no significant difference between the SI value of the moderately and poorly differentiated HCCs (P ＞ 0.05).ROC analysis showed that the optimal cutoff point of SI value in diagnosing well differentiated HCCs was 66.5.A cutoff SI value equal to or less than 66.5 was used to differentiate well-differentiated HCC from moderately-and poorly-differentiated HCC with a sensitivity of 90.1％ and a specificity of 71.9％.Conclusions On DWI,the tumors tended to show a brighter,visually evaluated signal intensity and higher quantitative signal intensity with decreasing histopathological differentiation (P ＜ 0.05).The quantitative signal intensity of HCC assessed with DWI signal intensity could only predict well differentiated HCC.It was limited in predicting histopathological differentiation of HCC using evaluating signal intensity and quantitative signal intensity of HCC assessed with DWI.

Objective To investigate the clinical effect of percutaneous transluminal angiography in diabetic infrapopliteal arterial disease patients and the influence of post-procedural intraluminal small dose urokinase infusion on infrapopliteal arterial blood flow.Methods From January 2011 to September 2013,37 limbs (16 left and 21 right) in 28 diabetic patients inflicted with infrapopliteal critical limb ischemia underwent endovascular recannalization at our institution and were retrospectively analyzed.Stenotic or occlusive lesions were demonstrated in 74 infrapopliteal vessels,including 30 anterior tibial arteries (ATA),22 posterior tibial arteries (PTA),and 22 peroneal arteries (PA).In 30 limbs,tandem lesions in iliac-femoral arteries were also diagnosed.Antegrade ipsilateral femoral access,retrograde contralateral femoral or brachial arterial access had all been adopted as well as both angioplasty and stenting.Case specific decisions were made based on pre-procedural computed tomographic angiogram (CTA).Ankle-brachial index (ABI) was recorded before and after each procedure.Urokinase was continuously infused through arterial sheath catheter into vessels of target limb from a microinfusion pump at 200 000 to 300 000 units per 24 hour for 48 hours after procedure.Angiogram was performed before and after thrombolysis therapy aiming to ascertain the number of frames of images obtained during the period of time it took blood flow to carry contrast medium from the level of tibial plateau to ankle,which was recorded as index frame count (IFC).Patients were followed up for at least 3 months.ABI and ultrasound or CTA were performed on each follow-up visit to validate patency.Quantitative data such as ABI value and IFC were analyzed using paired samples t-test.Results Thirty two limbs were radiographically recanalized by angioplasty or stenting.Technical success rate was 86.4％ (32/37).Average ABI of all limbs increased significantly from 0.70±0.31 to 0.90± 0.21 (t=10.734,P＜0.05).Of the 32 limbs recanalized,IFC decreased significantly from 6.3 ± 1.6 before thrombolysis to 4.7± 1.4 after thrombolysis (t=12.136,P＜0.05).Six rest pain patients reported significantly alleviated symptoms.Fourteen limbs presented with feet ulcers or gangrene.Of these patients after endovascular treatment,1 underwent ankle level amputation,3 underwent toe amputation and 3 patients who did not seek further treatment reported spontaneous autoamputation and wound healing.The remaining 9 patients reported wound healing within 1 to 3 months.Secondary angioplasty was needed for symptom recurrence in 3 limbs of 3 patients 3 to 24 months after first procedure.Conclusions Endovascular treatment of diabetic infrapopliteal arterial diseases exhibited significant short term effect and was safe to perform.Small dose urokinase infusion after recanalization procedure was safe and effective in helping to improve infragenicular blood flow.

Objective To assess the value of multi-slice spiral CT in the diagnosis of hepatic venous outflow obstruction (HVO) after liver transplantation. Methods Five patients with HVO were confirmed with digital subtraction angiography and epigastric tri-phase contrast-enhanced CT scans within 4-102 days after liver transplantation, and the CT dynamic enhancement features were retrospectively evaluated. Results Among 5 patients, 2 had middle hepatic vein obstruction, 1 had left hepatic vein obstruction, 1 had right hepatic vein obstruction, and 1 had middle hepatic vein and inferior caval vein obstruction. Contrast-enhanced CT showed typical liver congestion in all 5 patients. The liver parenchyma drained by obstructed hepatic vein was low-density on CT plain scans (1 patient showed mix-density caused by liver parenchyma hemorrhage), while no enhancement on artery phase, moderate enhancement on venous phase and high enhancement on delay phase were observed. During the venous phase, peripheral portal branches were invariably enhanced in the congested area of liver parenchyma. During the delay phase, opacification of the obstructed hepatic vein could be seen. After all patients had treated with interventional therapy, their clinical symptoms were improved, and 2 patients received contrast-enhanced CT scans after interventional therapy, which showed liver congestion relieved and obstructed hepatic vein opacificated well in venous phase. Conclusion Multi-slice spiral dynamic enhancement CT scans can accurately display the location of HVO and the extent of liver congestion.

Objective To assess the clinical value of transcatheter arterial chemoembolization (TACE) with polyvinyl alcohol (PVA) particles as embolic material in patients with primary hepatic cancer (PHC). Methods Twenty patients with PHC underwent TACE. The mixed emulsion of chemotherapy agents and lipiodol was given to embolize the tumor vssTranscatheter arterial chemoembolization using polyvinyl alcohol feeding artery of tumors. The tumors size, response rate and Alpha-Fetoprotein (AFP) value were monitored respectively at the end of the first month, the third month, the sixth month and the first year after TACE. The changes of liver function, including serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and total bilirubin (TBILI), were recorded within 1 week and 1 month after TACE. The time to progression and the overall survival were recorded. Results Compared with pre-TACE, the tumor size decreased obviously at the end of the first month, the third month, the sixth month and the first year after TACE (P<0.05), the response rate reached 80.00%, 90.00%, 95.00% and 95.00%, respectively. The AFP value decreased obviously. Serum AST, ALT and TBILI significantly increased in the first week after TACE (P<0.05), but returned to preoperative level within 1 month. The average follow-up time was (19.8±7.0) months (range 12-32 months), the time to progression was (17.0±6.8) months, and the overall survival was (19.3±7.0) months. Conclusion PVA particles are optimal embolic material for TACE of PHC. Superselective embolization is necessary in TACE to achieve effective tumor devascularization and reduce liver damage.

Objective To investigate the imaging characteristics of different biliary strictures after liver transplantation and their relationship with causes. Methods Forty-six patients with jaundice and biliary stricture were enrolled in this study.The diagnosis was confirmed by percutaneous transhepatic cholangiography (PTC).All the patients had hepatic arteriography with DSA or CTA and underwent liver biopsy.Their imaging characteristics were analyzed and the related statistic analysis was conducted.Results Anastomosis biliary stricture (ABS) was demonstrated in 21 cases,and non-anastomosis biliary stricture (NBS) with hepatic artery thrombosis (HAT) occurred in 13 cases,and there were 12 cases of NBS without HAT.PTC examination confirmed there were 26 cases of biliary stricture at hepatic hilum,and the incidence of biliary stricture in NBS group was significantly higher than that in ABS group (92％ vs.14.35％,P＜0.05).There were 31 cases of intrahepatic bile duct stricture,and the incidence in NBS group was significantly higher than that in ABS group ( 100％ vs.28.6％,P＜0.05).There were 33 cases of dilatation of intrahepatic bile duct,and the incidence in NBS without HAT group was significantly lower than that in ABS group and NBS with HAT group (16.7％,100％ and 76.9％ respectively) (P＜0.05).There were 21 cases of extrahepatic biliary dilatation,and the incidence in ABS group was significantly higher than that in NBS group (85.7％ vs. 12％,P＜0.05). There were 18 cases of stricture and dilatation in intrahepatic bile duct,and the incidence in NBS with HAT group was significantly higher than that in ABS group and NBS without HAT group (76.9％,28.6％ and 16.7％ respectively,P＜0.05).The results of the liver biopsy were accorded with the diagnosis of biliary stricture,Conclusion The different biliary strictures carry different imaging characteristics,including location of biliary stricture,and location and type of secondary biliary dilatation.